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ORIGINAL ARTICLE
Year : 2017  |  Volume : 15  |  Issue : 3  |  Page : 247-251

Does tooth loss have an emotional effect? A cross-sectional and comparative study on nondenture wearers and complete denture wearers


Department of Public Health Dentistry, Sri Sai College of Dental Surgery, Hyderabad, Telangana, India

Date of Web Publication18-Sep-2017

Correspondence Address:
M Jyothi
Department of Public Health Dentistry, Sri Sai College of Dental Surgery, Kothrepally, Vikarabad, Hyderabad - 501 101, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_46_17

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  Abstract 

Introduction: Teeth play various functional and esthetic roles. As any part of the body, even teeth loss gives one the feeling of being handicapped showing a negative impact on emotions. Sometimes, few people think that having 32 teeth and losing a few among them will not make a difference. Aim: To assess and compare the emotional effects due to loss of natural teeth in complete denture wearers and nondenture wearers. Materials and Methods: A hospital-based survey was conducted on complete denture wearers and nondenture wearers who were attending the outpatient department in a dental hospital for 2 months using a pretested, self-administered questionnaire. Results: Among them who were surveyed, 65.75% agreed accepting the tooth loss is difficult, only 30.13% felt that loss of teeth affected their self-confidence (P = 0.094), about 80.82% reported that natural teeth loss affected their eating efficiency, and 57.53% of them found it difficult while speaking to others. There was a significant difference between denture wearers and nondenture wearers when asked whether loss of teeth affected their looks, eating efficiency, and speaking difficulties (P = 0.000). Conclusion: Even though the majority of them found it difficult in accepting tooth loss, it did not affect their self-confidence majorly; however, most of them found functional difficulties with loss of natural teeth.

Keywords: Denture wearers, emotional effects, nondenture wearers, tooth loss


How to cite this article:
Anjum MS, Monica M, Rao K Y, Reddy P P, Hameed IA, Jyothi M. Does tooth loss have an emotional effect? A cross-sectional and comparative study on nondenture wearers and complete denture wearers. J Indian Assoc Public Health Dent 2017;15:247-51

How to cite this URL:
Anjum MS, Monica M, Rao K Y, Reddy P P, Hameed IA, Jyothi M. Does tooth loss have an emotional effect? A cross-sectional and comparative study on nondenture wearers and complete denture wearers. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2019 Dec 12];15:247-51. Available from: http://www.jiaphd.org/text.asp?2017/15/3/247/215061


  Introduction Top


Teeth play various functional and esthetic roles.[1] Having good teeth is all about quality of life, and as we advance in age, the ability to eat well becomes fundamentally important. A beautiful, radiant smile that does show healthy and natural teeth is one of the greatest assets any person can ever have and the mouth is always a focus of attention.[2] A beautiful smile symbolizes youth, health, and happiness. Loss of teeth shows an impact on one's smile leading to a loss of these symbols.[3] As any other parts of the body, even teeth loss gives one the feeling of being handicapped.[1] Teeth loss can rob much more than the ability to chew, eat, and speak properly. It has a serious social, psychological, and emotional consequences impacting on one's quality of life, self-image, and self-esteem.[4] The absence of one or more natural teeth is considered as a part of a natural process which accompanies aging. Few people experience it as a feeling of loss and few feel strong and prepared. It has been seen that elderly individuals take it for granted that edentulousness is accompanied with age and so develop the acceptance.[1]

A dentist in an attempt to replace the natural teeth usually thinks about restoring back the functional abilities. However, what about the adjustment and psychological reactions to the teeth loss? It is the factor that is often overlooked or briefly considered. A person's oral health status can affect them physically and psychologically and show a major influence on how they look, speak, chew, taste, and enjoy food. Social functions such as communication and esthetics may be more important than biting and chewing and may be main determinants in an individual's subjects need for the replacement of missing natural teeth.[5] It is natural to grieve when one loses one or all the natural teeth and they follow a similar pattern of reactions to loss like any other parts of the body.

A person may experience five stages of grief when they lose their teeth partially or completely. The first stage of loss is denial which is closely followed by anger. The third stage of bereavement is bargaining. This is followed by depression which is the most difficult stage to overcome and the final stage is acceptance where a person accepts the situation.[3]

Davis et al. concluded that many people have difficulty in terms of tooth loss and often feel less confident, restrict their social activities, and avoid forming close personal relationships.[6] Studies done on completely and partially edentulous subjects have shown that teeth loss does not have a marked emotional effect but affected their daily social activities.[7],[8]

Loss of natural teeth not only influences oral function but also influences the social life and social activities, leading to a decline in psychological well-being.[9] Many edentulous people feel psychologically that their dentures should function as same as their natural dentition.[10] Complete dentures are thought to be a positive step in improving health and functional abilities such as eating and speaking. There arises a question whether a complete denture improves the oral appearance and social interactions of an individual which might enhance their self-esteem and thus contribute to psychological well-being. Studies comparing the emotional effects of teeth loss in nondenture wearers and complete denture wearers are scarce. This led us to explore the differences in emotional feelings due to natural teeth loss in complete denture wearers and nondenture wearers? Thus, the present study aimed to assess and compare the emotional feelings due to natural teeth loss in complete denture wearers and nondenture wearers.


  Materials and Methods Top


A hospital-based survey was conducted on nondenture wearers and complete denture wearers attending the outpatient department in a dental hospital who were aged between 45 and 65 years. The study was carried out from September 2016 to October 2016 in a dental hospital at Vikarabad, Telangana. The ethical clearance was obtained from the Institutional Review Board. Verbal consent was taken from the participants willing to participate.

A questionnaire was prepared based on the previous literature[6],[7],[8] in English; later, it was translated into vernacular language (Telugu). It was pretested in a pilot study among 30 subjects for comprehension and accuracy. The reliability of the questionnaire was checked, and Cronbach's alpha value was found to be 0.731 and content validity ratio = 1. The questionnaire consisted of patient demographic details, reasons for loss of natural teeth, statements on emotional feelings due to teeth loss graded on a three-point Likert scale (agree, neither, disagree).

Complete denture wearers who were using dentures for the last 1 year who had come for a follow-up and nondenture wearers who were in the process of getting dentures for the first time were included in the study. Participants with communication difficulties, cognitive impairment, and not willing to participate were excluded from the study. A total of 103 participants who met the inclusion criteria were recruited. The questionnaire was given to the participants and was collected on the same day, and for those who were illiterate, a structured interview was carried out by an investigator.

Statistical analysis was done using SPSS version 20.0. United States, 2011. Descriptive statistics were done. Chi-square test was done to see the differences in distribution of subjects based on their age, gender, occupation, education, and per-capita income and to see an association between dental status and emotional feelings toward tooth loss. Level of significance was set at P < 0.05.


  Results Top


A total of 103 edentulous subjects aged 45–65 years participated in the hospital-based survey, of which 50 were complete denture wearers who were using dentures for the last 1 year and 53 were nondenture wearers who were completely edentulous. There were a total of 73 males and 30 females among the respondents. Majority i.e 64 participants were aged between 55-65 years, and the remaining were between 45-55 years old [Table 1]. The distribution of study participants in both the groups based on their demographic aspects showed an equal distribution in two groups [Table 2].
Table 1: Demographic details of the overall subjects

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Table 2: Distribution of study subjects in denture wearer and nondenture wearers groups based on their demographic details

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When emotional feelings due to natural teeth loss were compared between denture wearers and nondenture wearers, 50% of the complete denture wearers and 32% of nondenture wearers agreed that they were unconcerned when they lost their last tooth. About 76% of denture wearers and 62% of nondenture wearers never felt embarrassed discussing regarding natural tooth loss with their family or friends. No significant differences were found between both the groups in respect to these aspects. Around 46% of denture wearers and 69.8% of nondenture wearers found it difficult in accepting tooth loss, with a significant difference between both the groups (P = 0.043). Majority of the nondenture wearers, i.e., 73.5% of them, agreed that tooth loss affected their looks, whereas only 32% of the complete denture wearers felt the same with statistically significant difference between both the groups (P = 0.000). About 62% of the complete denture wearers and 94.3% of the nondenture wearers agreed that teeth loss affected their eating efficiency with a significant difference between both the groups (P = 0.000). Around 79.2% of the nondenture wearers and only 32% of the denture wearers agreed that they had difficulty while speaking to others with a significant difference between both the groups (P = 0.000) [Table 3].
Table 3: Comparison of emotional feelings between denture wearers and nondenture wearers

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  Discussion Top


Tooth loss is very traumatic and upsetting and is regarded as a serious life event that requires significant social and psychological readjustment.[11] Teeth have a symbolic significance, and loss of teeth may reflect impending loss of facial attractiveness and body degeneration.[12] Frustration sets in when a person starts to experience the difficulties that come with losing teeth, and only then, they truly realize the value of what was lost. However, even before they experience such challenges, it is the immediate changes in the physical appearance that will initially affect the person's psyche.[13] Loss of 1–2 teeth may not be that taxing, but loss of more number of teeth has a considerable functional and emotional impact on the person's life.[1] The physical aspects of tooth loss have been extensively studied, whereas the adjustment and psychological reactions related to tooth loss are less well-understood.[14]

A full-mouth rehabilitation of complete dentures might not completely but to some extent restore back the deprived functional abilities due to loss of natural teeth. This raises a question that does it even restore back the emotional feelings that are lost due to the absence of natural teeth. Hence, the present study attempted to explore emotional reactions to teeth loss and comparison of the feelings between the complete denture wearers and nondenture wearers attending the outpatient department of a dental hospital. In the present study, there were 50 complete denture wearers who were using dentures for the last 1 year and 53 nondenture wearers who had visited the hospital for getting dentures done for the first time.

Around 50% of the denture wearers and 32% of nondenture group were unconcerned about loss of their natural teeth. This is consistent with a study done by Naik and Pai,[8] where 48% of the edentulous subjects were unconcerned by loss of teeth. Majority of people who were not having dentures were grieved by loss of teeth when compared with ones who are using complete denture as they have undergone a recent transition to the edentulous state.[6]

When asked about discussing regarding teeth loss with family or friends embarrassed them, 68.9% of the subjects disagreed to this statement with no significant difference between the groups (P = 0.279). This is consistent with the findings of the studies done by Naik and Pai[8] and Scott et al.,[14] where majority of the subjects discussed with their family members, friends, and relatives. Acceptance of teeth loss is considered by the society as a normal part of aging with no social stigma.[8]

In the present study, 46% of the denture wearers and 70% of the nondenture group found it difficult in accepting the tooth loss. This finding is consistent with the studies done by Davis et al.[6] and Shah et al.,[7] where 42% of the subjects wearing complete dentures and 58% of the nondenture subjects reported the same. There was statistically significant difference between both the groups (P = 0.043) with a majority of nondenture wearers finding it more difficult in accepting teeth loss when compared with complete denture wearers. With increase in time and usage of prosthesis by denture wearers, they found it less difficult in accepting the teeth loss when compared with nondenture wearers.

About 70% of complete denture wearing subjects and 47% of nondenture wearers disagreed to the statement that they still have not accepted the teeth loss. The teeth provide the proper support and shapes of the lips and cheeks and appearance of a proper smile. Losing all these surely will cause a negative change in the original physical appearance of a person, thus causing an impact on self-confidence.[13] Only 20% of the denture wearers and 39.6% of the nondenture wearers agreed that natural teeth loss affected their self-confidence with no significant difference between both the groups (P = 0.094). This is similar to the findings in the study done by McMillan and Wong[15] in Hong Kong and Dable et al.[1] in India. As most of the study participants were from rural background loss of teeth might not have affected their self-confidence as that of urban people.

Loss of teeth gives rise to a “dished-in” appearance. The loss of alveolar bone height and width also results in marked changes in soft-tissue profile, particularly in the 1st year after tooth extraction.[12] When the subjects were asked about their change in facial appearance due to natural teeth loss, 73.5% of nondenture wearers supported to it whereas only 32% of the denture wearers agreed a change in facial appearance. There was a significant difference between both the groups (P = 0.000). This is consistent with the study done by Shah et al.,[7] where 86% of the respondents reported a change in shape of the face. The change in shape of the face was found to be less pronounced in subjects using complete dentures where their appearance has been improved with the use of dentures when compared with nondenture wearers.

About 62% of denture wearers and 94% of nondenture wearers accepted that teeth loss affected their eating efficiency and restricted their food choices with significant difference between both the groups (P = 0.000). This finding is seen to be consistent with studies done by Naik and Pai[8] and McMillan and Wong,[15] where majority of the edentulous people find restriction in their food choices. Loss of teeth imposes a handicapping situation showing impact on the nutritional status, and rehabilitation with complete denture can improve their eating efficiency to some extent than without any prosthesis.

The loss of teeth certainly will have a significant impact on the person's ability and confidence in being able to communicate with others and also in being able to express one's self through speech.[13] In the present study, only 32% of denture wearers and about 79% of nondenture wearers found it difficult while speaking to others (P = 0.000).

People may feel embarrassed about their appearance and do not want to go out and engage in social interaction and activities such as laughing and eating out in public due to natural teeth loss.[4] In the present study, about 22% of denture wearers and 47% of nondenture wearers avoid going out in public due to natural teeth loss with a significant difference between the groups (P = 0.027). The above findings were consistent with findings in the studies done by Naik and Pai[8] and McMillan et al.,[15] where more than half of the respondents reported the same. Replacing the natural teeth with prosthesis can overcome the problems in restricting the social activities to some extent than without prosthesis.

Thus, loss of natural teeth shows a direct affect on the functional efficiency and an indirect effect on their emotional feelings which must be focused and given importance. Edentulism is thought to be prevailing more in the elderly population. It is the responsibility of the dental professionals to guide and motivate people to retain natural teeth. If not, they should be motivated to get a new prosthesis, taking into consideration to overcome emotional as well as functional effects due to natural teeth loss.

As the present study was done only on a small sample, an in-depth analysis of the emotional feeling toward natural teeth loss should be assessed taking a large sample to truly represent the data. Moreover, as this was done in a hospital setting which might overestimate the results, future studies should be conducted outside without the involvement of hospital setting.


  Conclusion Top


Subjects with complete dentures were found to have less difficulty in accepting the tooth loss and have a less change in facial appearance when compared with nondenture wearers. They also had less restriction in their food choices and social activities when compared with nondenture wearers. Thus, an oral health-care provider should consider even the emotional feelings into account apart from functional activities while fabricating prosthesis for completely edentulous person.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dable RA, Yashwante BJ, Marathe SS, Gaikwad BS, Patil PB, Momin AA. Tooth loss – How emotional it is for the elderly in India? Oral Health Dent Manag 2014;13:305-10.  Back to cited text no. 1
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2.
Lee B. Things you Should Know about Teeth: The Complete Guide to Dental Health and Beauty; U.S.A; Author House Publishing; 2007. Available from: https://www.books.google.co.in/books?isbn=1434312879. [Last accessed on 2017 Jan 29].  Back to cited text no. 2
    
3.
Goodman S. Got Teeth? A Survivor Guide. How to Keep your Teeth or Live Without Them. U.S.A: Dog Ear Publishing; April, 2007 Available from: https://www.books.google.co.in/books?isbn=1598582992. Last accessed on 2016 Sep 05].  Back to cited text no. 3
    
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Ronda N. Edentulism Causes and Consequences of Tooth Loss. Available from: http://www.yourdentistryguide.com/tooth-loss/. [Last accessed on 2016 Nov 04].  Back to cited text no. 4
    
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Ageing: Scientific Aspects; 1st Report of Session 2005-2006. By Great Britain: Parliament: House of Lords: Science and Technology Committee. Available from: https://www.books.google.co.in. [Last accessed on 2017 Jan 16].  Back to cited text no. 5
    
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Davis DM, Fiske J, Scott B, Radford DR. The emotional effects of tooth loss: A preliminary quantitative study. Br Dent J 2000;188:503-6.  Back to cited text no. 6
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7.
Shah RJ, Diwan FJ, Diwan MJ, Chauhan VJ, Agrawal HS, Patel GC. A study of the emotional effects of tooth loss in an edentulous Gujarati population and its association with depression. J Indian Prosthodont Soc 2015;15:237-43.  Back to cited text no. 7
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8.
Naik AV, Pai RC. Study of emotional effects of tooth loss in an aging north Indian community. ISRN Dent 2011;2011:395498.  Back to cited text no. 8
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Emami E, de Souza RF, Kabawat M, Feine JS. The impact of edentulism on oral and general health. Int J Dent 2013;2013:498305.  Back to cited text no. 9
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Anwar A, Kumar B, Akhtar MJ, Rahman MZ. Complete denture satisfaction among population in Bihar - A study. IOSR J Dent Med Sci 2015;14:68-72.  Back to cited text no. 10
    
11.
Omar R, Tashkandi E, Abduljabbar T, Abdullah MA, Akeel RF. Sentiments expressed in relation to tooth loss: A qualitative study among edentulous Saudis. Int J Prosthodont 2003;16:515-20.  Back to cited text no. 11
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Allen PF, McMillan AS. A review of the functional and psychosocial outcomes of edentulousness treated with complete replacement dentures. J Can Dent Assoc 2003;69:662.  Back to cited text no. 12
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Atienza CN. Loss of Teeth as Disability. Available from: http://www.ngipinatbp.blogspot.in/2016/02/loss-of-teeth-as-disability.html. [Last accessed on 2016 Jan 26].  Back to cited text no. 13
    
14.
Scott BJ, Leung KC, McMillan AS, Davis DM, Fiske J. A transcultural perspective on the emotional effect of tooth loss in complete denture wearers. Int J Prosthodont 2001;14:461-5.  Back to cited text no. 14
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McMillan AS, Wong MC. Emotional effects of tooth loss in community-dwelling elderly people in Hong Kong. Int J Prosthodont 2004;17:172-6.  Back to cited text no. 15
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  [Table 1], [Table 2], [Table 3]



 

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